AUGUSTA — When his health center launched a new drug program last year, Noah Nesin knew there would be demand among a segment of opioid users needing fast access to medication-assisted treatment.

Now, in less than nine months, Penobscot Community Health Care’s “bridge” clinic has treated 184 people from seven counties – without ever advertising the facility’s existence.

“I totally underestimated the demand for this and told everybody that it was going to be a couple of a patients a week,” Nesin said Friday. “And it wasn’t. From the outset, it wasn’t.”

New statistics released Thursday underscore the long, difficult fight Maine faces addressing an opioid addiction crisis that continues to kill hundreds of people every year. After a decline in overdose deaths from 2017 to 2018, the number of drug-related fatalities appears to be creeping up again – with 277 deaths during the first nine months of 2019 – despite the significant medical and financial resources being directed at the crisis.

Nesin and other health care professionals believe so-called “bridge clinics” – which provide users access to medication-assisted treatment without obligating them to counseling or other treatment services – could help reach individuals most at risk of becoming another mortality statistic.

Penobscot Community Health Care and seven other “federally qualified health centers” are asking lawmakers to partner with them on a pilot project that aims to open 20 such “bridge clinics” across southern, central and coastal Maine. The challenge, advocates and lawmakers acknowledge, will be coming up with the money to cover the higher costs of operating facilities that, by their nature, require constant juggling of staff resources.

“I am a huge fan of this project but we have not identified a funding source for the $920,000,” said Gordon Smith, who leads the state’s opioid response efforts for Gov. Janet Mills’ administration.

On Friday, members of the Legislature’s Health and Human Services Committee voted unanimously to endorse the pilot project and send their recommendation to the budget-writing Appropriations and Financial Affairs Committee. To reduce the price shock, representatives of the Maine Primary Care Association, which represents community health centers, pledged to continue exploring alternative funding sources. And Health and Human Services Committee members suggested potentially reducing the number of clinics, at least initially.

“I believe it is money well-spent to it put into your hands, but I do appreciate that there needs to be some wiggle room as you are working with Appropriations,” said Rep. Patricia Hymanson, D-York.

The idea behind “bridge clinics” is to recognize the spectrum of individuals with substance use disorders and that no single treatment program will help every person.

These clinics are often referred to as “low-barrier/rapid-access” facilities because they provide immediate access to the type of medication-assisted treatment – such as suboxone or methadone – that has proven to be among the most effective forms of treatment for opioid addiction. Patients are provided information about additional treatment, therapy or counseling options but are not required to sign up for them in order to continue receiving medication-assisted treatment.

The low-barrier approach is aimed at helping stabilize someone who may be in crisis and, therefore, at greater risk of an overdose. The facilities then also provide “rapid access” to further treatment by connecting individuals with trained staff persons within five days of a person deciding that they were ready for treatment.

“What we are trying to do with this pilot is truly get at reducing the rate of overdose deaths and increasing the true rate of people who can access treatment,” said Lori Dwyer, president and CEO of Penobscot Community Health Care. Dwyer told lawmakers that the program “ensures treatment when a person is ready and not when our schedules allow” by creating a flexible model of care.

“Just like we wouldn’t dream of telling a diabetic we are not going to give them insulin because we don’t have any appointment that day, we are not going to tell someone who needs medication for opioid use disorder that we can’t give them medication either because we don’t have an appointment or they are unwilling to undergo counseling at that time,” Dwyer said.

But having such a flexible model poses administrative and financial challenges. Facilities must quickly rearrange staff or pro-actively keep appointment slots open (and potentially empty) in anticipation of potential clients. And then there is the simple reality that people coming to the clinic often lack health insurance and may be in such an unstable state because of their substance use disorder that they are unable to keep follow-up appointments.

Penobscot Community Health Care estimates the “bridge clinic” has cost $220,000 to operate.

On Thursday, the Maine Attorney General’s Office released new statistics showing that 277 people died of drug overdoses between January and September 2019, with opioids listed as a key factor in 84 percent of those deaths. While full statistics for 2019 are not yet available, the trendline suggests Maine could see a slight uptick over the 354 overdose deaths recorded in 2018.

Portland police, meanwhile, have responded to 11 overdose calls since Jan. 2, five of which were fatal.

Smith, who is the Mills administration’s point person on the opioid crisis, said he would love to see 20 low-barrier/fast-access clinics operating in the state and told lawmakers he knows of others that could be added. He praised the work of federally qualified health centers in responding to the drug crisis, particularly in rural areas of Maine, where it is more difficult for residents to get health care.

Nesin, the chief medical officer who works at the Bangor “bridge clinic,” pointed to a University of Pittsburgh study suggesting that drug overdose deaths nationally could continue to rise because of the complexity of the drug crisis.

“Although the rates we have are unacceptable, it probably isn’t appropriate . . . to say this represents a failure of our efforts to treat this problem,” Nesin said. “These kinds of low-barrier clinics get at the population most at risk of dying in the short-term. More of this should be better. We treat people from seven different counties in the bridge clinic right now, so expanding this model and making it more available closer to home is really critical to getting at those kinds of issues.”

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